<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="HandheldFriendly" content="True">
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="viewport"
	content="width=device-width, initial-scale=1.0, user-scalable=no, minimal-ui">
<title>Scan credit card information</title>
<link rel="stylesheet" href="css/scan-credit-card.css">
</head>
<body>
	<div class="box">
		<form class="form" action="/" method="POST">
			<fieldset>
				<div class="fieldLine">
					<label for="holdername">Name on card</label> <input type="text"
						id="holdername" placeholder="Name on card" name="holdername"
						required>
				</div>

				<div class="fieldLine">
					<label for="card">Credit Card Number</label> <input type="text"
						id="card" placeholder="Credit card number" name="card" required>
				</div>

				<div class="fieldLine">
					<label for="month">Expiration Date</label> <input id="month"
						type="text" placeholder="MM" name="month" required> <input
						id="year" type="text" placeholder="YYYY" name="year" required>
				</div>
			</fieldset>

			<div class="form-action">
				<button type="submit" class="btn">Continue</button>
			</div>
		</form>
	</div>
</body>
</html>